Push-Back Repair Using Nasal Muscosal Flaps: Results

Abstract

One of the most neglected operations in cleft palate surgery is the push-back procedure. This operation, popularized primarily by Dorrance and Wardill, was described by Dorrance in 1925 (3). Although von Lagen— beck, Veau, and other great men contributed much to this field, we believe that their procedures, for the most part, are obsolete in modern cleft palate surgery. Unfortunately, most plastic surgeons still cling to the old tradition and the push—back enjoys only occasional consideration, playing second fiddle to the 'classic' cleft palate operation after von Langenbeck, Vintage 1861. The usual result of these lesser-known procedures is a short palate and poor'speech. Therefore, we advocate a routine push-back for nearly all cases of cleft palate to obtain the best possible result in every case. The raw surface on the nasal side of the displaced palatal flaps, following push-back surgery, has been a matter of concern since post—operative con-tracture negates much of the length gained. Some have closed their eyes to this problem, while others have used split grafts which also contract (I , 3). Cronin (2) published a method of eliminating the raw surface by the elevation of flaps from the nasal floor. An evaluation of this method is presented. Summary of Technique of Nasal Flap Method Mucoperiosteal flaps are elevated from right and left sides of the palate and displaced posteriorly aided by removal of the posteromedial wall of the palatine foramen. The free edges of the soft palate cleft are freshened and the posterior half is closed in layers by catgut mattress sutures. Rectangular nasal mucosal flaps are then elevated (Figures 1 through 5) by three incisions made in the nasal floor by a small right angle knife and a Freer septal knife inserted through the nose. These nasal flaps, based on the soft palate at the bony junction, are tacked onto the raw surface of the